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A particularly virulent strain of E. coli has killed at least 16 people and sickened many others.
A particularly virulent strain of E. coli has killed at least 16 people and sickened many others.
 

(CNN) -- An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause.

Where did the infection come from?

The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit.

The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals.

What food types are affected and from where?

Infections have so far only been linked to Spanish cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected.

says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

Who are the victims?

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection.

However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 adults at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized.

What is E. Coli?
Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water of food -- especially raw vegetables and undercooked meat.

It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a life-threatening kidney failure.

Why is this strain so deadly?

The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics.

In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure.

How far has it spread?

The ECDPC says the outbreak it is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to Germany.

The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

What advice is being given to consumers?

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says.

What is the economic fallout?

With exports of Spanish vegetables "paralyzed" according to officials, weekly losses of about ¢æ200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth ¢æ8.6 billion.

Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain.

Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this health crisis with our products."

Is it likely to spread outside the European Union?

While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States.

There is also the risk of so-called "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

The CNN Wire contributed to this report

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